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Even the latest Guidelines for Allergic Conjunctival Disease did not include evidence for preventive treatment of hay fever with antiallergic eye drops.
In the last few days, it seems that more people have clear findings of allergic conjunctivitis.
Various kinds of care are provided based on “clinical practice guidelines.”
Evidence for “Preventive Treatment of Hay Fever (Initial Therapy)”
What are clinical practice guidelines?
A document that presents recommendations considered optimal for supporting decision-making by patients and healthcare providers, by weighing a systematic review of evidence on clinically important medical practices, its overall evaluation, and the balance of benefits and harms.
Japan Council for Quality Health Care
Clinical practice guidelines are documents containing recommendations to optimize patient care, based on a systematic review of the scientific evidence and an assessment of the benefits and harms of multiple treatment options.
Institute of Medicine (IOM), United States
National Academy of Medicine (NAM), United States
✔ For an important issue, the CQ (clinical question),
✔ based on scientific evidence
✔ a “recommendation” is presented.
Clinical practice guidelines in Japan have now also come close to international standards.
The new guideline: “Clinical Practice Guidelines for Allergic Conjunctival Disease, 3rd Edition”
“Preventive treatment,” in which antiallergic eye drops are instilled before pollen is released, was not described in the 2010 guidelines for allergic conjunctivitis1either.
Clinical Practice Guidelines for Allergic Conjunctival Disease (2nd Edition), Journal of the Japanese Ophthalmological Society 114(10), 829-870, October 10, 2010
The Japanese Society of Ocular Allergy Research was the main body that prepared it.
The new guidelines
In 2020, the Japanese Society of Ocular Allergy released the 3rd edition of the guidelines.
It can now be downloaded from the website of the Japanese Ophthalmological Society.
Clinical Practice Guidelines for Allergic Conjunctival Disease, 3rd Edition
Recommendations and strength of recommendation for CQs (clinical questions):
Nine summaries are described.
1. Are steroid eye drops useful for perennial allergic conjunctivitis?
Steroid eye drops are conditionally recommended for seasonal allergic conjunctivitis and perennial allergic conjunctivitis. (Weak recommendation)
2. Are steroid eye drops useful for vernal keratoconjunctivitis?
Steroid eye drops are conditionally recommended for vernal keratoconjunctivitis. (Strong recommendation)
3. Are steroid eye drops useful for atopic keratoconjunctivitis?
Steroid eye drops are conditionally recommended for atopic keratoconjunctivitis. (Strong recommendation)
4. Are cyclosporine eye drops useful for vernal keratoconjunctivitis and atopic keratoconjunctivitis?
Cyclosporine eye drops are conditionally recommended for vernal keratoconjunctivitis. They are also conditionally recommended for atopic keratoconjunctivitis, but are not covered by insurance. (Weak recommendation)
5. Are cyclosporine eye drops more useful than steroid eye drops for vernal keratoconjunctivitis and atopic keratoconjunctivitis?
For vernal keratoconjunctivitis, cyclosporine eye drops are conditionally recommended over steroid eye drops. (Weak recommendation)
6. Is combined use of cyclosporine eye drops and steroid eye drops useful for vernal keratoconjunctivitis and atopic keratoconjunctivitis?
For vernal keratoconjunctivitis, combination therapy with cyclosporine eye drops and steroid eye drops is conditionally recommended for proliferative conjunctival changes.
(Weak recommendation)
7. Are tacrolimus eye drops useful for vernal keratoconjunctivitis and atopic keratoconjunctivitis?
In vernal keratoconjunctivitis and atopic keratoconjunctivitis, tacrolimus eye drops have been suggested to improve corneal epithelial damage and giant papillae, and their use is recommended.
However, tacrolimus eye drops are not covered by insurance for atopic keratoconjunctivitis. (Strong recommendation)
8. Are tacrolimus eye drops more useful than steroid eye drops for vernal keratoconjunctivitis and atopic keratoconjunctivitis?
For the treatment of vernal keratoconjunctivitis and atopic keratoconjunctivitis, tacrolimus eye drops are recommended over steroid eye drops. (Weak recommendation)
9. Is combined use of tacrolimus eye drops and steroid eye drops useful for vernal keratoconjunctivitis and atopic keratoconjunctivitis?
In vernal keratoconjunctivitis and atopic keratoconjunctivitis, combination therapy with tacrolimus eye drops and steroid eye drops is conditionally recommended for severe proliferative conjunctival changes. (Weak recommendation)
This time, too, no evidence for “preventive treatment” is described.
Evidence for preventive treatment of hay fever
Hay fever is classified as the “seasonal” type of allergic conjunctivitis.
There have been several reports on preventive treatment,2but the scientific evidence has not been established.
We have introduced a description from the ear, nose, and throat field on the basis for preventive treatment of cedar pollen allergy3.
・Using an antihistamine before cedar pollen is released made it possible to control the severity of allergic rhinitis.
・This result is important for both quality of daily life and reducing medical costs.
Preventive eye drops for hay fever (allergic conjunctivitis):
Sufficient evidence has not yet been shown, but we practice with the information from the ear, nose, and throat field in mind.
Antihistamine eye drops
Alesion®, Patanol®, Intal®, Livostin®, Rizaben® eye drops, and others
Steroid eye drops are also used.
Preventing allergic conjunctival disease: self-care
It is good to be mindful of the following:
(From the Clinical Practice Guidelines for Allergic Conjunctival Disease, 3rd Edition)
○ Removing indoor dust mites
Keep the room temperature at 20°C or below and humidity at 50%; keep the air well ventilated
Bedding measures: air bedding in the sun on fine days; use a vacuum cleaner and an air purifier
○ Outdoor hay fever measures
Use pollen information
○ Pollen-protective glasseseffect
Glasses alone can reduce the amount of pollen that gets onto the surface of the eye
○ Wearing contact lenses
Switch to glasses as much as possible so as not to worsen conjunctivitis
○ Eye washing
Eye washing with preparations that contain no preservatives, or with artificial tears, is useful
Avoid frequent eye washing with tap water
Take care that dirt around the eyes and antigens stuck to the skin do not come into contact with the surface of the eye
(← This is what happens with eye washing using a cup)
○ Clothing when going out
Wool and similar fabrics easily catch pollen
Slippery fabrics make it harder for pollen to stay on clothing
Wear a coat, scarf, hat, and so on, and take them off before entering the front door
○ Indoor pollen measures
Do not bring pollen into the house
On days with high pollen counts, keep the windows closed and do not hang futons outside
Clean regularly with a vacuum cleaner / use an air purifier
Apps useful for preventing hay fever (iPhone / Android)
Santen Pharmaceutical introduced us to an app.
Kayumi Dasu
https://www.santen.com/jp/healthcare/eye/library/allergic_conjunctivitis/kayumidas
Check the “eye itch warning,” which pollen counts alone cannot tell you, up to a week ahead!
For a comfortable life, daily measures against itchy eyes according to the situation
Alarms prevent you from forgetting to use your medicine or attend appointments!
Easily record and share changes in your condition with the allergy diary!
It also delivers useful information such as various measures against itchy eyes!
(From the Santen Pharmaceutical website)
Kayumi Dasu | Santen Pharmaceutical
